Those participants in the high-risk groups were found to significantly associated with certain psychiatric conditions. These included: anxiety/tension, depression, having serious thoughts of suicide, experiencing hallucinations, and difficulties concentrating. In addition, participants who had reported being bothered by psychological or emotional problems, within the last 30 days, were also significantly more likely to be in the high-risk HIV / AIDS group. Specifically in adolescents, drug use significantly increases high-risk HIV / AIDS behaviors, due to the perception of enhanced sexual arousal combined with reduced inhibitions and increased perceived social stature. In Central and Southeast Asia, heroin use and needle sharing are increasingly common high-risk HIV / AIDS behaviors. For these reasons, individuals who are at risk for being infected by HIV or who are already HIV positive, are individuals who use drugs. The prevention intervention programs for these individuals, as well as the treatment and care programs, need to also address the individual's drug abuse and dependence. Kresina, Bruce and McCance cite past studies that show that in programs when substance abuse and dependence is not addresses, the patients are not as likely to take part in anti-retroviral treatment for HIV / AIDS infection. However, for programs that do also provide substance abuse treatment as part of the program, they are more likely to begin treatment for their HIV / AIDS infection.
This is in contrast to the results of those who had tested positive for HIV / AIDS, with only 15% of respondents who were HIV / AIDS positive being in the high-risk group, according to Fitzgerald, Lundgren and Chassler. In fact, those participants who were HIV / AIDS positive were approximately 82% less likely to be found to engage in the defined high-risk behaviors, when compared with those who had not tested HIV / AIDS positive. In addition, at the bivariate level, the researchers found no significant difference in employment or homelessness for the two groups. The other factor that was also found to be significantly negatively associated with high-risk HIV / AIDS behaviors was prescription of psychiatric medications. It was found that participants of the study who had been prescribed medications for psychological or emotional problems were 61% less likely to take part in high-risk HIV / AIDS behaviors, when compared to participants who did not report having medications prescribed.
Fitzgerald, Lundgren and Chassler surmise that their findings suggest that the relationship injection drug using women have with spouses can be a significant factor in exposing these women to high-risk HIV / AIDS behaviors. In addition, testing for HIV / AIDS and ensuring female drug users receive the proper psychiatric medications may help protect them from the increased relationship risks associated with living with a spouse. Their "study findings verify the importance of interpersonal relationships in women's HIV / AIDS risk and are consistent with recommendations made by Amaro (1995) who suggests a switch in the focus of HIV / AIDS research from using individualistic behavioral and learning theory models to more holistic models addressing the complex set of issues women face in our society" (72).
Medication assisted treatment in the treatment of drug abuse and dependence in HIV / AIDS infected drug users:
As with the other two sets of researchers, Kresina, Bruce and McCance understand the strong association between HIV / AIDS infection, drug use and associated behaviors and deem this the twin epidemics -- HIV / AIDS and drug/alcohol use. This results in challenges in the management of medical care for health care providers, as well as researchers, working in the international HIV prevention and treatment fields.
Access to care and treatment, medication adherence to multiple therapeutic regimens, and concomitant drug -drug interactions of prescribed treatments are difficult barriers for drug users to overcome without directed interventions. Injection drug users are frequently disenfranchised from medical care and suffer sigma and discrimination creating
additional barriers to care and treatment for their drug abuse and dependence as well as
HIV infection (354). .
The researchers cite past research that has demonstrated how medication-assisted treatment of substance abuse dependence has been a valuable component of HIV / AIDS prevention intervention. Their article presents the total evidence that supports how important this medication-assisted treatment is for the treatment, care and prevention of HIV / AIDS infected people who are also drug and/or alcohol abusers.
As Fitzgerald, Lundgren and Chassler also had noted, Kresina, Bruce and McCance also recognize the relationship between the use and abuse of drugs and high-risk HIV / AIDS behaviors that increase the chance of infections. The authors specifically recognize the consumption of alcohol, which results in enhanced sexual sensation seeking and a greater HIV / AIDS risk. This theory is supported by World Health Organization publications and research studies. Studies in Sub-Saharan Africa has found that heavy alcohol use has resulted in less condom use, a greater number of sexual partners, and a greater acquisition of sexually transmitted diseases, including HIV / AIDS. The same is true for ...
To determine the appropriate substance abuse treatment component, Kresina, Bruce and McCance surmise that the first step is to identify both the quantity and pattern of substance use. "Substance abuse is a complex physiological, social and behavioral disorder that often coexists with psychiatric illness as well as co-morbid medical conditions" (355). As such, substance users should also be screened for co-morbid psychiatric conditions as a component of any medical intervention, in addition to a comprehensive drug use treatment program. Additionally, the authors note that drug abuse treatment is a powerful strategy in HIV / AIDS prevention. Adding a mental health services components to a substance abuse treatment program further enhances the medical outcomes for treatment.
Substance abuse can be chronic and include relapses; however, as Kresina, Bruce and McCance note, it is treatable. Although addictive substances are widely available across society, those who are vulnerable to abuse and dependence have a complex behavioral component, that is affected by psychological, biological and environmental factors and influences. For this reason, substance use disorders must be recognized as a disease, and appropriate treatment services have to be an essential part of clinical care for patients with HIV / AIDS. Likewise, to successfully treat HIV disease, in patients who are drug users, attention and treatment of the associated substance use disorder is necessary. These treatments typically consist of two primary components: a) pyschosocial therapy and b) medication-assisted treatment or pharmacotheraphy. The unique treatment plan used with be determined based on the drug the patient is using and the length and pattern of their drug use, as well as the psychosocial character of the patient.
Kresina, Bruce and McCance note that for opiod dependence with co-morbid HIV infection medication-assisted treatment may include methadone, buprenorphine and naltrexone. For alcohol dependence medication-assisted treatment often includes disulfiram, naltrexone or acamprosate for those with HIV infection. Stimulant dependence, such as cocaine or methamphetamine, does not currently have FDA-approved medications; however, Kresina, Bruce and McCance cite a recent, randomized placebo-controlled trial which showed positive results for naltrexone for amphetamine addiction. The authors also note the increasing evidence of buprenorphine/naloxone as a combination therapy to be used for cocaine users, as well as users of multiple drugs. Lastly, recent pharmacotherapeutic treatment strategies for drug abuse involving ketamine or gamma-hydroxybutyrate are being developed and have shown promising case report literature.
Currently, there is an international effort to increase the availability of HIV / AIDS anti-retroviral drug treatment. However, only a small portion of those afflicted with HIV / AIDS have access to this treatment. Drug users who often suffer from discrimination, stigma and poverty. This group of HIV infected persons often are the least likely to receive anti-retroviral therapy, if they aren't being concurrently treated for drug dependence. These patients are often the least to be considered for HIV treatment. These patients, especially injection drug users, often also suffer other co-morbid conditions and thus experience even poorer outcomes when afflicted with HIV / AIDS. "Injection drug users also experience unmet health service needs, suboptimal ambulatory care, missed medical appointments and poor medication adherence" (Kresina, Bruce & McCance 357). As such, it becomes clear that despite the inherent interconnectedness between injection drug use and HIV / AIDS, medication-assisted treatment is needed not only to address the substance abuse issues, but also to treat the disease.
Substance abuse and HIV / AIDS are found to be coexisting in up to 80% of cases in some countries. For this reason, it's important to understand the implications HIV / AIDS has on the diagnosis, prevention and treatment of substance use disorders. For women, a positive diagnosis of HIV / AIDS was not typically a powerful catalyst in seeking drug treatment. However, during the drug treatment process, a transformation regarding the consideration of their disease often occurs with patients, transforming it from a reason to continue to use…
Specifically in adolescents, drug use significantly increases high-risk HIV / AIDS behaviors, due to the perception of enhanced sexual arousal combined with reduced inhibitions and increased perceived social stature. In Central and Southeast Asia, heroin use and needle sharing are increasingly common high-risk HIV / AIDS behaviors. For these reasons, individuals who are at risk for being infected by HIV or who are already HIV positive, are individuals who use drugs. The prevention intervention programs for these individuals, as well as the treatment and care programs, need to also address the individual's drug abuse and dependence. Kresina, Bruce and McCance cite past studies that show that in programs when substance abuse and dependence is not addresses, the patients are not as likely to take part in anti-retroviral treatment for HIV / AIDS infection. However, for programs that do also provide substance abuse treatment as part of the program, they are more likely to begin treatment for their HIV / AIDS infection.
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